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Chapter 3 Patient Safety, Communication, and Recordkeeping Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. Learning Objectives Describe how to apply good body mechanics and posture to moving patients. Describe how to ambulate a patient and the potential benefits of ambulation. Write definitions of key terms associated with electricity including voltage, current, and resistance. Identify the potential physiologic effects that electrical current can have on the body. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 2 Learning Objectives State how to reduce the risk of electrical shock to patients and yourself. Identify key statistics related to the incidence and origin of hospital fires. Identify impediments to care and risk in the direct patient environment. List the conditions needed for fire and how to minimize fire hazards. State how communication can affect patient care. Describe the two patient identifier system. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 3 Learning Objectives List the factors associated with the communication process. Describe how to improve your communication effectiveness. Describe how to recognize and help resolve interpersonal or organizational sources of conflict. List the common components of a medical record. State the legal and practical obligations involved in record keeping. Describe how to maintain a problem-oriented medical record. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 4 Patient Safety Continuum Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 5 Safety Considerations Patient Movement & ambulation Good posture minimizes risk of injury when moving patients or heavy equipment RTs should use their legs with straight spine to lift patients & heavy objects Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 6 Basic Body Mechanics Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 7 Moving the Patient in Bed Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 8 Moving the Patient in Bed Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 9 Moving the Patient in Bed Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 10 Ambulation Extended bed rest can lead to new medical problems, such as atelectasis Ambulation (walking) helps restore & maintain normal body function Ambulation should begin as soon as patient is stable & free from severe pain Ambulation can reduce length of hospital stay Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 11 Extended bed rest can result in which of the following? A. atelectasis B. Diabetes C. COPD D. asthma Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 12 Electrical Safety Fundamentals of Electricity Electricity moves from point A to point B due to differences in voltage Voltage is power behind electrical energy Most homes & hospitals are powered w/ 120-V power sources Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 13 Electrical Safety (cont.) Power sources w/ high voltage have potential to generate large amounts of electrical current Current is directly related to voltage difference between point A & point B, & inversely related to resistance of object Objects w/ little resistance (e.g., copper wire) allow maximum current to flow Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 14 Electrical Safety (cont.) Objects w/ high resistance (e.g. rubber tubing) allow minimal or no current to flow Current represents greatest danger when electrical shorts occur Current is reported in amperes; resistance is reported in ohms Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 15 Electrical Safety (cont.) Harmful effects of current depend on: Amount of current flowing through body Path it takes Duration current is applied High currents passing through chest can cause ventricular fibrillation, diaphragm dysfunction, & death Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 16 High currents that pass through the chest can cause all of the following , except: A. Death B. ventricular fibrillation C. diaphragm dysfunction D. atelectasis Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 17 Electrical Safety (cont.) Electrical devices have “hot” wire & “neutral” wire Neutral wire completes circuit by taking current to ground Ground is low-resistance pathway to point of zero voltage Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 18 Electrical Safety (cont.) Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 19 Electrical Safety (cont.) Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 20 Electrical Safety (cont.) Preventing Shock Hazards Most shock hazards are caused by inadequate grounding All electrical equipment should be connected to grounded outlets w/ three-wire cords All electrical equipment used for patient care must be checked by qualified expert on regular basis Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 21 Most shock hazards are caused by what? A. B. C. D. inadequate grounding caregiver neglect faulty wiring oxygen leakage Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 22 Fire Hazards 1980: about 13,000 fires were reported in health care facilities in U.S. By 2000: number dropped to 2,000 Dramatic decrease due to education & strict fire-code enforcement Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 23 Fire Hazards (cont.) Most hospital fires start in kitchen About 15% of hospital fires occur in patient care areas & are often related to smoking Hospital fires cause approximately $9 million in damage Fires in areas where oxygen is being used are especially dangerous Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 24 Fire Hazards (cont.) Fires in oxygen-enriched atmospheres (OEAs) are larger, more intense, faster burning, & more difficult to extinguish Hospital fires are more serious b/c evacuation of critically ill patients is difficult Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 25 What makes hospital fires more serious than those at other non-medical facilities? A. B. C. D. the amount of people in the hospital not enough emergency exits the amount of nitrogen dioxide in use the evacuation of critically ill patients is difficult Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 26 Fire Hazards (cont.) 3 conditions must exist for fire to start: Flammable material must be present Oxygen must be present Flammable material must be heated above its ignition temperature Oxygen is not flammable, but: It can greatly accelerate rate of combustion Oxygen supports combustion Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 27 Fire Hazards (cont.) Flammable material should be removed from vicinity of oxygen use Ignition sources, such as cigarette lighters, should not be allowed in rooms where oxygen is in use Children should not play with toys that may create spark when oxygen is in use Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 28 Fire Hazards (cont.) PASS – fire extinguisher training P – pull pin A – aim nozzle S – squeeze handle S – sweep nozzle across base of fire Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 29 Fire extinguisher training includes learning which acronym ? A. B. C. D. RACE NBRC CBC PASS Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 30 Fire Hazards (cont.) RACE – core fire plan R – Rescue patients in immediate area of fire. A – Alert other personnel to fire. C – Contain the fire; shut doors to prevent spreading of fire. E – Evacuate other patients & personnel. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 31 General Safety Guidelines Direct patient environment should be: Free of impediments to care • Beware of anything creating direct fall risk RTs responsibility to position equipment: tubing & treatments out of way of potential risk Disaster preparedness includes: transport & transfer of critically ill, & preparation for loss of electricity Magnetic resonance imaging (MRI) safety No metal components or objects allowed in MRI suite! MRI compatible ventilators, oxygen supplies, & ancillary equipment. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 32 General Safety Guidelines (cont.) Medical gas cylinders: Proper storage & handling to prevent fire risk • Explosive release of high pressure cylinders Toxic effects of some gases National Fire Protection Association (NFPA) Regulates storage of medical gases Monitoring by The Joint Commission ( TJC) • Hospital accrediting organization Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 33 What is the role of the RT when it comes to the patient’s direct environment? A. to position the equipment, tubing and treatments out of the way as much as possible. B. to keep the patient in supine position at all times C. hold the patient’s arm while they are walking D. to make sure their nurse wears special shoes so as not to trip over the tubing Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 34 Communication in Health Care Communication has 5 basic components: Sender, Message, Channel, Receiver, & feedback Success as RT depends on your ability to communicate well with patients & other members of team. Poor communication can: Limit your ability to treat patients Work well with others Find satisfaction in your employment Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 35 Elements of Communication Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 36 Communication in Health Care (cont.) Effective communication: most important aspect of safe patient care. TJC’s goals for 2010, improve: Accuracy of patient identification Communication of critical test values among caregivers • Should include “Read-back” scenario verifying accurate reporting & recording of test values. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 37 Communication in Health Care (cont.) All healthcare personnel must use “two patient identifier” before initiating care, which includes: Patient name Birth date Medical record number Factors affecting communication Verbal &Internal qualities (e.g., values, experiences, etc.) of sender & receiver nonverbal communication skills of sender Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 38 Factors Influencing Communication Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 39 Effective Communication Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 40 Improving Communication Share information rather than tell it Seek to relate to people rather than to control them Value disagreement as much as agreement Use effective nonverbal communication techniques Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 41 Improving Communication (cont.) The Practitioner as Listener Work at being good listener Stop talking; avoid interrupting speaker Resist distractions; tune them out Keep your mind open; be objective Hear the speaker out before making evaluation Maintain composure; control emotions Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 42 Improving Communication (cont.) Providing feedback Attending; involves use of gestures & confirming remarks Paraphrasing; repeating others’ response in one’s own words Requesting clarification; should be nonjudgmental in nature Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 43 Improving Communication (cont.) Providing feedback Perception checking; done by confirming or disproving more subtle components of communication interaction Reflecting feelings; provide opportunity for patients to express & reflect on their emotions Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 44 By allowing the patient to reflect their feelings, you are: A. providing them the opportunity to express and reflect on their emotions B. repeating their response in your own words C. clarifying any miscommunication D. comforting an anxious patient by explaining the unknown Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 45 Conflict and Conflict Resolution Sources of Conflict Poor communication is primary source of conflict in organizations Structural problems occur more often w/ larger organizations & when employees have little control over their work Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 46 Sources of Conflict (cont.) Personal behavior; various personalities & beliefs can create conflict in workplace Role conflict occurs when employee is pulled in different directions by individuals w/ different expectations Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 47 Conflict Resolution There are 5 basic strategies for handling conflict: 1. 2. 3. 4. 5. Competing; represents assertive & uncooperative conflict resolution strategy (e.g., boss uses his or her authority to settle dispute) Accommodating; represents opposite of competing; conflict settled by “giving in” Avoiding; both parties do not pursue their concerns; may lead to unresolved issues Collaborating; involved parties try to find mutually satisfying solutions to conflict Compromising; middle-ground strategy that combines assertiveness & cooperation Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 48 Conflict Resolution (cont.) Deciding which type of conflict resolution strategy to use requires insight into context of problem Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 49 Recording Keeping Medical record or chart provides written statements of occurrences pertaining to patient Medical records are strictly confidential & are protected under Health Insurance & Portability Act (HIPPA) Includes confidential health insurance or billing information Records represent legal document & could be used in court Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 50 Recording Keeping (cont.) Federal government would like all medical recordkeeping done electronically by 2014 Electronic medical record (EMR) is new way practitioners can document care Record keeping is major significant duty you perform Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 51 General Rules for Record Keeping Entries should be printed or handwritten Do not use ditto marks Do not erase Record each patient interaction & sign entry Document patient complaints Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 52 General Rules for Record Keeping (cont.) Do not leave blank lines Use standard abbreviations only Use present tense Use proper spelling Document all important conversations Be accurate Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 53 General Rules for Record Keeping (cont.) Each health care facility has its own specification for keeping medical records Documentation flow sheets are designed to: Briefly report data Decrease time spent in documentation Use standardized terms & abbreviations TJC has published a “Do Not Use” abbreviation list developed to reduce potential errors (see Table 3-2 in text) Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 54 Documentation Form Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 55 Problem-Oriented Medical Record POMR: documentation format used by some health care institutions POMR has 4 basic parts 1. 2. 3. 4. Database Problem list Plan Progress notes Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 56 Problem-Oriented Medical Record POMR progress notes use SOAP format: S = Subjective (patient’s complaints) O = Objective (results of physical exam, lab tests, ABGs, chest radiograph, etc.) A = Assessment (What is problem?) P = Plan (How is problem to be treated?) Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 57 SOAP Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 58 When documenting notes in POMR, what formant should be followed? A. B. C. D. RACE PASS SOAP NBRC Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 59